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Introduction: The blunting of the expected improvement in cardiovascular health over the past decade has been attributed in part to the substantial increase in the prevalence of obesity. Atrial fibrillation and heart failure are among the cardiovascular diseases with increasing incidence in the US. We sought to evaluate the effect of obesity on the predicted 6-month mortality in our patients with atrial fibrillation [AF] and acute coronary syndrome [ACS] utilizing the GRACE score [GS], a validated risk assessment model for predicting death within 6-months of hospital discharge.Methods: Eighty patients, 88% black, 54% female, mean age 68, +/-12, h/o AF admitted with ACS were included.Results: An extraordinarily high prevalence of DM and HTN [46% and 95% respectively] and obesity [46%] were noted. The mean weight: 87 Kg, +/- 23. The mean BMI was 31 kgm2, +/-10; median BMI 29 kgm2 and 25% had a BMI of 35 kgm2 or greater, (Chart). Seventy-five percent of the cohort had clinical or radiographic evidence of congestion. Ejection fraction: mean 45%, +/-17. B-type natriuretic peptide [BNP] level: mean 765 pg/ml. BNP was significantly and negatively related to obesity [BMI p= 0.0001; r= -0.422; weight p= 0.001; r= -.359]. This inverse relationship of BNP and obesity was most apparent when comparing the level of BNP in patients who were at or above the median BMI (29.3 kgm2), p= 0.001, (Fig). Although we found a significant direct association of the GS with age [p<0.001; r= .62], troponin [p=0.001; r= .74] and BNP [p= 0.018; r= .41], no independent significant relationship was apparent with obesity [weight p= 0.54; r= -.11, or BMI p= 0.11; r= -.28].Conclusions: In a traditionally high risk cohort with AF and ACS a high prevalence of obesity was recorded. Clinical or radiographic evidence of congestion was present in the majority. We found no significant link between obesity in this population and the GS—predictor of 6-month mortality. Can this be another cardiovascular paradox? Lengthier outcome studies of larger cohorts are warranted.